Wonderful photo. So sorry that the lymphoma is resistant to the chemo. Can you check and see if any other chemo agents are being used at Florida or any other vet schools with a medical vet oncologist? I know that lymphoma treatment is not an area that is well researched, but there may be other alternatives. You have given Calvin months of good health with the meds. As long as he is happy and your finances are ok, I would not give up yet.
AKB- thank you as always for your support and encouragement.
Things looked quite dire about two weeks ago so I attempted to contact Dr. Theon at UC Davis for a second opinion. He has been on vacation and will return next week. In the meantime I spoke to some knowledgeable folks over there who told me that if Cal’s lymphoma was resistant to all 4 drugs (the fifth, DOX he had the bad reaction too) then there were 3 options.
1)try DOX again (and attempt to minimize the bad side effects)
2) a maintenance dose of steroids
3) other chemo drugs that have not been well studied in horses (which would require an official consult with Dr. Theon)
However, it appears that CTX (cyclophosphamide) one of the initial 5 drugs we tried may be working. He is at New Bolton today to get another, higher dose of CTX so we will know very soon if its working.
The oncologists and the vets at New Bolton seem hesitant to try “other” chemo drugs on him bc as you mentioned they aren’t well studied and come with their own set of scary side effects. I’m also not sure I would be able to sign off on a more “experimental” type treatment anyway. I question myself with every decision I’ve made with respect to his care and treatment. I just never know if I’m doing the right thing.
As for the Devon pictures, I never got them. I occasionally google myself and Cal to see if an article was ever written abroad and then I could attempt to obtain the pics that way but no such luck. And thankfully, the sting of not getting the pics has lessened (mostly due to the fact that I have been able to keep showing him… I initially thought Devon would be our last show).
Ivy, please know I am thinking of you and wishing you well. I admire you so much for what you are doing for Calvin. Hugs and prayers to both of you…
Ivy, you are advocating very well for Cal. If there is a good solution, you will find it. Cal looks great in that photo; shiny, vigorous, and happy.
Runn. Dox can cause heart issues and while I certainly plan to keep riding him as long as he is feeling well, I see no reason to risk my safety and his by taxing his heart over a 1.25m course. So, I’m on currently looking at prizelists with the hope of getting him out to one last horse show this weekend!
And one last thing, here is my daughter course walking with me last weekend 
just too cute not to share:
[IMG]http://i1285.photobucket.com/albums/a595/ivyhall1/Mobile%20Uploads/10542069_798396100978_69299943268392531_o_zps0503f034.jpg)
Ivy, my fingers are firmly crossed for you! Doxorubicin is a very pretty drug, so there’s that (it’s a beautiful red colour, and I guess that’s where the name came from). 
Maybe some time off from work will help with his battle, anyway.
Jingles aplenty.
Those fences are huge, Ivy! I’m glad you, Cal and your daughter have been able to show and have fun during the last few months. I hope the doxorubicin works for Cal. Keep us updated, good or bad.
SIGH
Cal was scheduled to receive the DOX this week. I was very anxious about giving it to him after he reacted so poorly to it the first time but it seemed like we were/are running out of options.
Then just this weekend, a horse who had been diagnosed with lymphoma, not long after Cal, died after being administered DOX. This was his second dose. With his first dose he had had side effects but not as serious as Cal’s…but apparently his side effects were worse this time around and could not be managed (it should be noted that while he was diagnosed at New Bolton and NB vets were being consulted he was treated at another facility. He was not at New Bolton or under their direct care when he passed). Results of his autopsy should be available later this week.
I had come to know his owner over this past year as we dealt with the ups and downs of having a horse with lymphoma. I am heartbroken for her and her horse.
So, we have yet another plan for Calvin. We will try Cytosar this week. Its a newer less studied chemo drug (in horses) but what studies have been done indicate that it is well tolerated in horses.
Also, a small animal oncologist at Upenn who is working on lymphoma vaccines in dogs (“next level” immunotherapy type stuff) has offered to try to do the same thing for Cal. This is highly experimental but the risks are fairly low so we are going to try this as well. I believe Cal will be the first horse to undergo such treatment.
And while its a long shot as Cal has never had symptoms, but there is apparently link between EHV-5 and lymphoma. Studies have shown that when the EHV-5 is treated with anti-virals the lymphoma will also go into remission. He was tested for EHV-5 last week and we should have the results soon, but like I said its a long shot as he has never shown any symptoms.
I am so thankful to all the vets at New Bolton and UPenn who have not yet given up on Calvin.
What happened when Cal had the doxyrubicin the first time?
Keep us posted on the Cytosar, immune therapy and the antivirals. I know that sooner or later, our guy may relapse. He has been fine for ?2 years now, but we don’t have a plan organized in case of relapse. Our guy’s only issue, that may or may not be related to the chemo (particularly the steroid) is that he now has a very tiny, barely visible, cataract in one eye.
Give Cal a hug and a treat from us.
Was Cal premeditated before the first doxyrubicin? What about your friend’s horse? I remember my daughter giving something as a premed before the doxyrubicin. I can find out what it was if you want to research it.
AKB
Before the DOX Calvin was medicated with flunixin and diphenhydramine. And was then treated as needed after given the dox. The research papers on dox seem describe side effects as occurring 4-6 hours post treatment but Cal’s went of for two days and it took even longer for his blood values to normalize. That is why we removed it from the initial protocol.
Ucarlo, the horse who passed was also pre and post medicated (but again, Ucarlo was not at New Bolton at the time of treatment, so I don’t have all the details). Ucarlo had the fever and rapid heart rate like Calvin and his could not be managed with medication. I don’t know the results of the autopsy… bit it was probably heart attack.
Cal has shown NO side effects from the cytosar. YAY! I’ll be heading out there shortly to see if I notice any improvement in tumor size but its probably a little too early for that.
In other news, CALVIN TESTED POSITIVE FOR EHV-5! I know its a loooooong shot but he will start antiviral meds as soon as we can get our hands on them, probably on saturday (8/30/14). He will get them every 8 hours and I will be handling the dosing myself (its too expensive a drug and his illness is too serious to leave it to anyone else) so I hope he doesn’t mind me waking him up at 4am everyday
I also got more information on the immunotherapy and it sounds like it is unlikely to move forward. Next week we will have biopsies taken and frozen (I didn’t have the biopsies done this week bc he will be doing leadline with my daughter on saturday and he already looks a bit cut up from previous biopsies) just in case something changes and they can move forward. Not only will there be a lot of red tape to get through, but if I am understanding correctly, the vaccine only seems to work when the animal is currently in remission… and that is what we are having a hard time achieving right now.
I’m sure I’m forgetting something… this has been a crazy week!
Jingles for you and Calvin. Good luck with the antiviral meds.
What is the antiviral you are giving? Acyclovir or valcyclovir? If that works, it should be a good treatment for many. At least in people, the usual antivirals are very well tolerated.
Good luck with the lead line class! Lots of jingles for good boy, Cal. Tell your daughter not to expect to win the lead line class. When my kids were little, it was usually some kid on a short, plump, impeccably polished, grey pony who won.
He has already had h. He does not like having a full tube of meds shot into the back of his mouth but he is being a good boy. I imagine if anyone else tried to dose him he would be very difficult. So barring an emergency I plan to exclusively handle the antiviral treatment (plus, its expensive and as this is a potentially life saving treatment, I trust no one).
I have a ton of questions for the vets and I have been doing my best not to bother them over the holiday weekend I’m not even clear as to what sort of side effects I should be watching for, but he is watched so closely as is so if his behavior changes at all we will notice (knocks on wood).
Onto the FUN STUFF! I decided to officially retire Cal from showing after this weekend. So on Friday he went and did a jr/ao jumper class with me and put in a beautiful CLEAR round. Then on Saturday he went and did lead line with the little one. He got to her show and was in horse show mode. All puffed up, chomping on the bit and ready to jump. I seriously considered scratching but after walking around a bit he settled, I threw her on they were GREAT. He would root with the reins a bit (I had a bit of a death grip on him and he of course hates that) and my daughter was cool as a cucumber, she would say “whoa whoa calvin” and then pet him and tell him he was a good boy. AND we actually got 4th place out of a large class! It will forever be my most prized ribbon.
And now for pictures:
[IMG]http://i1285.photobucket.com/albums/a595/ivyhall1/Mobile%20Uploads/photo2_zps25c5693e.jpg)
(as for the retirement, if this antiviral treatment works and he goes into remission I will probably bring him back in 2015, fingers crossed)
Great photos, Ivy. Depending on how long Cal is going to be on the valacyclovir, you may look into whether Wedgewood or another pharmacy has experience compounding it into something tasty. You also may want to look at the pharmokinetic studies and see if it could be given twice a day instead of every 8 hours. In people, it is usually given twice a day, although I think for shingles/herpes zoster, it is 3 times a day. Giving a med every 8 hours is going to wear you out.
Thanks for the update. Cal looks great.
Rooting for you guys. I am not in the know about any of these, so no advice-- but sending good healing thoughts!
http://www.ncbi.nlm.nih.gov/pubmed/18638291
This suggests that you may be able to give the valacyclovir every 12 hours after the first few days, as long as the dose is recalculated. Talk with the vets and see what they want to do. I don’t know how you are holding up with dosing every 8 hours.
vxf111- THANK YOU! Any and all support and encouragement is greatly appreciated!
As for the valacyclovir we did get it from wedgewood and it is apple flavored. It actually smells pretty good but obviously I can’t (shouldn’t) do a taste test I’m betting its not that bad though, he is just a surly dude.
Some of my many questions for the vets tomorrow include, do I have to strictly stick to the 8 hour schedule and will we move to twice a day at some point?
AKB- thanks for continuing to post on this thread and consistently giving me things to think about and questions to ask. You must be a doctor, or just a genius, or maybe both…?
Actually, a pediatric nurse practitioner. When you work with kids, you learn to look for the easiest way to accomplish your goals.
I’ve been following, hope things get better. Keeping you and your boy in my thoughts and prayers.
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